妇女及儿童尿液分析复检规则的建立与应用

目的建立LabUMat全自动尿液分析工作站对妇女、儿童尿液分析镜检的复检规则。方法收集2014年8月至9月在妇女儿童医疗中心门诊就诊和住院的儿童和妇女的随机尿液常规标本共1 036份,用LabUMat全自动尿液分析仪分别进行尿液干化学和有形成分分析;检测完毕后采用双盲法进行显微镜检查,采用人工镜检与全自动沉渣分析仪器检测平行比对的,探讨复检规则及复检方法,并计算复检规则的真阳性率、假阳性率、真阴性率、假阴性率(漏诊率)、复检率。根据自动化尿液分析工作站的检测方法,根据妇女儿童尿液标本的特点,参照在《中华医学检验杂志》发表的有关尿液有形成分的复检规则的方案,设计制订适合妇女儿童的复检规则。选取2014年10月门诊和住院的随机尿液常规标本300份进行复检规则的验证。结果建立复检规则的1 036份尿液标本中,阳性标本占35%,阴性标本占65%。其中RBC阳性标本占65.30%,WBC阳性标本占53.32%,管型(CAST)阳性标本占3.86%。验证规则的符合率为86.5%,漏诊率为0.5%,复检率为21.7%。300份尿液常规标本进行复检规则的验证,验证结果符合率为91.67%,漏诊率0.67%,复检率为19.67%,图片审核修正后的复检率为8.67%。结论针对朗迈全自动尿液分析工作站,根据妇女儿童尿液标本的特征,制订适合本实验室的复检规则及方法能够有效地筛选异常标本,结合图片人工审核,可显著减少工作量。     

URIT-1500尿干化学分析仪与AVE-764B尿有形成分分析仪联合尿液检测复检规则的制定和应用

目的建立URIT-1500尿干化学分析仪(简称URIT-1500)联合AVE-764B尿有形成分分析仪(简称AVE-764B)进行尿液检测的复检规则。方法收集1 113例尿液样本,采用URIT-1500和AVE-764B分别进行尿液干化学和有形成分检测。采用双盲法进行人工显微镜检查,并分别记录尿液干化学结果、AVE-764B原始结果和人工校正后结果、人工显微镜结果,以人工显微镜结果均值为判断标准,设计4种方案。方案1:尿干化学潜血(BLD)、白细胞酯酶(LEU)、亚硝酸盐(NIT)、蛋白(Pro)任一参数报警;方案2:尿有形成分检测白细胞(WBC)、红细胞(RBC)、管型(Cast)任一结果报警;方案3:尿有形成分结果经人工图片修正后WBC、RBC、Cast任一结果报警;方案4:尿有形成分人工图片修正审核后RBC、WBC、Cast的结果与尿干化学BLD、LEU、NIT、Pro结果不符。随机选取280份尿液样本对该复检规则进行临床验证,评价其有效性。结果以人工显微镜结果为标准,用于建立复检规则的1 113例样本中,阳性样本占31.54%(351/1 113),其中RBC阳性占24.08%(268/1 113)、WBC阳性占14.82%(165/1 113)、Pro阳性占21.65%(241/1 113)、Cast阳性占3.5%(39/1 113);制定的4种方案复检率分别为40.79%(454/1 113)、44.65%(497/1 113)、27.04%(301/1 113)、25.07%(279/1 113),假阴性率分别是23.81%、19.79%、15.03%、1.62%。随机选取280例尿液样本对复检的规则进行验证,该规则假阳性率为8.85%,假阴性率为2.27%,符合率为93.21%,复检率为16.79%。结论 URIT-1500和AVE-764B联合检测尿液的最佳复检方案是干化学BLD、LEU、NIT、Pro结果与有形成分RBC、WBC、Cast人工图片审核结果不符的联合检测。该规则复检率较低(25.07%),漏检率﹤5%。     

Urit-1500尿液分析仪检测尿细胞成分结果分析

目的 探讨Urit-1500尿液分析仪检测尿液红细胞(RBC)、白细胞(WBC)等细胞成分的临床准确性。方法 选择该院2013年6~10月份收集的1 085份尿液标本作为研究资料,分别采用Urit-1500尿液分析仪测定与尿沉渣显微镜镜检,并对尿液分析仪检测尿细胞成分结果进行分析。结果 Urit-1500尿液分析仪测定1 085份尿液标本中:其测定RBC、WBC的结果与显微镜法符合率分别为93.8%(1 018/1 085)、94.0%(1 020/1 085);RBC阳性295例中经显微镜法镜检阴性49例,占16.6%;RBC阴性790例中经显微镜法镜检阳性18例,占2.3%;WBC阳性197例中经显微镜法镜检阴性28例,占14.2%;WBC阴性888例中经显微镜法镜检阳性37例,占4.2%。结论 Urit-1500尿液分析仪法检测尿RBC、WBC时应结合显微镜镜检,并结合其他检验指标及临床资料进行综合分析,尽量减少误诊和漏诊。     

IQ-200全自动尿沉渣分析仪镜检复检规则制订与应用

目的结合尿干化学分析和有形成分分析,制订IQ-200全自动尿沉渣分析仪的复检规则。方法选择该院2011年7月至11月600份新鲜尿液标本,其中500份用于建立复检规则,100份用于验证所建立的规则。所有标本通过AX-4280干化学分析仪、IQ-200全自动沉渣分析仪检测,进行红细胞（RBC）、白细胞（WBC）、脯氨酸（PR0）及管型（CAST）分析。针对自动化尿常规的不同检测方法,设计了4种复检方案。通过统计分析,建立不同检测方法的自动化尿常规分析的复检规则。结果采用该院原IQ-200尿有形成分分析仪的参考范围,尿沉渣显微镜镜检结果显示,500份用于建立复检规则的标本中,阳性占47．4％,阴性占52．6％。在阳性标本中,WBC阳性者最多,占70．9％,其次为RBC,占63．3％。4种方案的假阴性率（漏检率）分别为10．0％、7．6％、1．0％和0．80％;复检率分别为38．8％、43．2％、47．2％和40．6％。采用100份临床标本对所建立的复检规则（方案4）进行验证,其漏检率为0．0％,复检率为47．0％。结论方案4的漏检率最低,复捡率也较低,是理想的复检方案。     

不同原理尿液分析仪检测尿有形成分结果比较及显微镜复检规则探讨

目的 分析尿有形成分分析仪、尿干化学分析仪及显微镜尿沉渣结果 的差异,建立显微镜复检规则.方法 以UF-1000i尿有形成分分析仪及AX-4280尿干化学分析仪构成检测流水线,对临床尿标本先用流水线进行红细胞(RBC)、白细胞(WBC)及管型(CAST)检测,再用显微镜进行结果 验证.结果 UF-1000i检测RBC、WBC灵敏度高于AX-4280,但特异度低于AX-4280;流水线检测尿标本的阴性预测值达100.00%.UF-1000i分析仪与显微镜尿沉渣WBC、RBC、CAST检测结果 存在明显差异(χ2值分别为16.41、13.47、16.41,P＜0.05).建立适合该流水线的显微镜复检规则.结论 UF-1000i和AX-4280分析仪检测结果 有可能存在差异,此时不能以UF-1000i代替显微镜尿沉渣检查,需参照相应的复检规则进行复检,保证检测结果 准确性.     

干化学法和显微镜法检测尿液中红白细胞结果分析

目的 探讨干化学法能否完全替代显微镜法检测尿液中RBC、WBC.方法 通过干化学法和显微镜法检测300份尿液标本,对两种方法 测得的尿液中的RBC和WBC结果 进行分析.结果 300份尿液经干化学法检测RBC阳性108例,经显微镜复查仅38例阳性,阳性符合率为35.2%;干化学法检测RBC阴性192例,镜检阴性191例,符合率为99.5%;干化学法检测WBC阳性95例,镜检复查阳性71例,阴性24例,两种方法 阳性符合率为74.7%;干化学法检测WBC阴性205例,镜检复查阴性191例,阳性14例,阴性符合率为93.2%.结论 干化学法测得RBC阳性结果 必须镜检;干化学法测得WBC阳性结果 必须镜检.     

AVE-763尿沉渣自动分析流水线与显微镜检查结果比较及复检规则的建立

目的分析尿液干化学分析(简称干化学)和有形成分分析(简称尿流式)及显微镜尿沉渣结果的差异,建立显微镜复检规则。方法以AVE-763尿有形成分分析仪及GEB600尿干化学分析仪构成检测流水线,对临床尿标本先用流水线进行红细胞(RBC)、白细胞(WBC)、管型(CAST)及潜血(BLD)、中性粒细胞酯酶(LEU)、蛋白(PRO)检测,再用显微镜进行验证。结果GEB600和AVE-763两者检测均正常或同时异常的标本用显微镜复检,结果之间的差异无统计学意义(χ2=1.46,P=0.23)。AVE-763与GEB600两者检测结果不符合标本,经显微镜进行RBC、WBC、CAST检测,结果差异有统计学意义(χ2=16.75、15.29、79.18,P=0.001)。结论 AVE-763与GEB600两者检测结果不符合时,不能以AVE-763代替显微镜尿沉渣检查,需参照相应的复检规则进行复检,保证检测结果准确性。     

尿液整体化分析和显微镜检查联合检测临床应用价值分析

目的 探讨尿液整体化分析联合显微镜检查的指征,分析其在临床实际应用中的价值.方法 采用UF-1000i尿有形成分分析仪和AX-4030尿干化学分析仪对2 356例尿标本进行整体化分析;根据显微镜复检规则确定需进行显微镜复检的标本,以整体化分析联合显微镜检查作为研究组;由2名主管检验师采用双盲法对同份标本进行显微镜检查,作为对照组.对不同组的检测结果进行统计学分析.结果 尿液整体化分析红细胞(RBC)、白细胞(WBC)、管型(CAST)检测结果与对照组差异有统计学意义(P＜0.05);研究组RBC、WBC、CAST检测结果与对照组差异无统计学意义(P＞0.05);尿液整体化分析联合显微镜检查的特异度高于整体化分析.结论 尿液整体化分析和显微镜检查联合检测可在保持检测特异性的同时,提高工作效率及检验质量,为临床诊断和治疗提供可靠的依据.     

三种方法联合检测尿液有形成分的比较和评价

探讨Sysmex UF-50尿流式细胞仪、干化学分析仪及尿沉渣镜检三种方法检测尿液中红细胞（RBC）、白细胞（WBC）和管型（CAST）的应用及影响因素。方法对640例病人的尿液分别用UF-50尿沉渣分析仪、干化学分析仪及尿沉渣镜检三种方法进行检测,并对结果进行比较。结果 UF-50检测RBC、WBC和CAST的阳性率分别为：29.38%、24.38%和8.75%。干化学法检测RBC和WBC的阳性率是33.90%和15.1%;尿沉渣镜检法检测RBC、WBC和CAST的阳性率分别为：19.22%、20.94%和2.03%。结论 UF-50尿流式细胞仪和干化学分析仪不能取代尿沉渣镜检,建议三种方法联合应用,减少检验误差,提高尿液分析质量。     

干化学法与镜检法分析尿液白细胞和红细胞的比较

探讨干化学法与尿显微镜法检测尿中白细胞和红细胞的差异情况。对260例病人尿液标本分别用干化学分析仪和尿沉渣显微镜分析WBC和RBC,对其检验数据进行统计学分析。干化学仪法与显微镜法检验WBC的符合率为：阳性符合率84.62%,阴性符合率95.80%,假阳性率4.20%,假阴性率15.38%。检测RBC的符合率为：阳性符合率90.00%,阴性符合率89.44%,假阳性率10.56%,假阴性率10.00%。尿液干化学法检出率高,省时、省力,适合筛查;但其假阳性和假阴性较高,故不能完全取代显微镜法。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.